The biological rationale for testosterone therapy in aromatase inhibitor–associated joint morbidity lies in the premise that affected patients have a reduced ability to convert endogenous testosterone to 5-alpha-dihydrotestosterone. This potent testosterone metabolite appears to be important in reducing the proinflammatory interleukins present in the synovium of patients with inflammatory joint disease, Dr. Birrell explained.
“It's really quite interesting that women on aromatase inhibitors have a significant increase in Sjögren's syndrome, where it has been demonstrated that there is a perturbation in the ability to convert testosterone into activated dihydrotestosterone,” he observed.
Session chair Dr. Charles L. Loprinzi of the Mayo Clinic in Rochester, Minn., commented that he considers both the testosterone and high-dose vitamin D trials to be pilot studies which, although encouraging, don't rise to the level of being practice changing.
Dr. Birrell said that crossover studies of testosterone therapy for aromatase inhibitor–associated joint pain will be difficult to conduct.
“Women on testosterone in this trial were very keen to stay on it,” he noted.
Dr. Birrell's study was also supported by a research grant from AstraZeneca. Dr. Birrell disclosed that he is a stockholder in Chavah Pty Ltd., which is developing novel cancer therapies.
If we don't monitor patients on high–vitamin D regimens for urinary calcium, they may develop kidney stones.
Source DR. RASTELLI
The safety data were reassuring, with good tolerability of testosterone therapy at both doses.
Source DR. BIRRELL